Sex-based utilization and outcomes of cold-stored whole blood for trauma resuscitation: Analysis of a prospective multicenter study

Shea Gallagher; Joshua Dilday; Chaiss Ugarte; Stephen Park; Anaar Siletz; Kazuhide Matsushima; Morgan Schellenberg; Kenji Inaba; Joshua P Hazelton; John Oh; Jennifer Gurney; Matthew J Martin; and the EAST Whole Blood Multicenter Collaborative

doi:10.1097/TA.0000000000004431

Sex-based utilization and outcomes of cold-stored whole blood for trauma resuscitation: Analysis of a prospective multicenter study

J Trauma Acute Care Surg. 2024 Sep 3. doi: 10.1097/TA.0000000000004431. Online ahead of print.

Authors

Shea Gallagher¹, Joshua Dilday, Chaiss Ugarte, Stephen Park, Anaar Siletz, Kazuhide Matsushima, Morgan Schellenberg, Kenji Inaba, Joshua P Hazelton, John Oh, Jennifer Gurney, Matthew J Martin; and the EAST Whole Blood Multicenter Collaborative

Affiliation

¹ From the Division of Trauma and Acute Care Surgery, Department of Surgery (S.G., J.D., C.U., S.P., A.S., K.M., M.S., K.I., M.J.M.), Los Angeles General Medical Center, Los Angeles, California; Division of Trauma and Acute Care Surgery, Department of Surgery (J.D.), Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Trauma & Critical Care Surgery, Department of Surgery (J.P.H.), WellSpan York, York; Division of Trauma and Acute Care Surgery, Department of Surgery (J.O.), Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania; and Department of Surgery (J.G.), Joint Trauma System, San Antonio, Texas.

PMID: 39225986
DOI: 10.1097/TA.0000000000004431

Abstract

Background: Resuscitation with cold-stored whole blood (WB) has outcome benefits, but benefits varied by patient sex is unknown. There are also concerns about alloimmunization risk for premenopausal females given WB, leading to some protocols excluding this cohort. We sought to analyze WB utilization, outcomes, and disparities by patient sex.

Methods: This is a secondary analysis of a prospective multicenter study of WB resuscitation. Patients were stratified by sex and compared by transfusion strategy of WB or component therapy (CT). Generalized estimated equation models using inverse probability of treatment weighting were utilized.

Results: There were 1,617 patients (83% male; 17% female) included. Females were less likely to receive WB versus males (55% vs. 76%; p < 0.001), with wide variability between individual centers (0%-33% female vs. 66%-100% male, p < 0.01). Male WB had more blunt trauma (45% vs. 31%) and higher shock index (1.0 vs. 0.8) compared with the male CT cohort (all p < 0.05) but similar Injury Severity Score. The female WB cohort was older (53 vs. 36) and primarily blunt trauma (77% vs. 62%) compared with the female CT cohort (all p < 0.05) but had similar shock index and Injury Severity Score. Male WB had lower early and overall mortality (27% vs. 42%), but a higher rate of acute kidney injury (16% vs. 6%) vs. the male CT cohort (all p < 0.01). Female cohorts had no difference in mortality, but the WB cohort had higher bleeding complications. Whole blood use was independently associated with decreased mortality (OR, 0.6; p < 0.01) for males but not for females (OR, 0.9; p = 0.78).

Conclusion: Whole blood was independently associated with a decreased mortality for males with no difference identified for females. Whole blood was significantly less utilized in females and showed wide variability between centers. Further study of the impact of patient sex on outcomes with WB and WB utilization is needed.

Level of evidence: Prognostic/Epidemiological; Level IV.